Instructions for Autobiography
In preparation for your individual interview, please prepare an autobiography. We are
hoping to learn how you became who you are today and how you will parent (or are parenting).
Please write a narrative that addresses the following questions in a thorough and thoughtful manner
and submit to your counselor. Please also complete and submit attached pages.
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Where were you born?
Who raised you?
Who lived in your house as a child?
Choose 3 adjectives or words to describe your relationship with your mother as a child.
Choose 3 adjectives or words to describe your relationship with your father as a child.
How are you similar to your mother?
How are you dissimilar to your mother?
How are you similar to your father?
How are you dissimilar to your father?
What were each of your parents’ best and worst qualities?
Describe your relationship with your parent(s) today.
If you have siblings, describe your relationship with them as a child.
Describe your relationship with your siblings as an adult.
Describe how you were disciplined growing up. Who typically disciplined you and for
what?
Describe times when felt disappointed in your life time.
Describe times when you felt frightened or worried as a child. Who comforted you during
those times? How were you comforted?
Describe times when you did not feel safe as a child (e.g. emotionally, physically or
sexually).
Describe times you may have felt rejected as a child.
What values and rules did you have in your family? How did you learn what they were?
Describe any significant illness or addiction that you or family members have experienced.
Include such issues as sexual abuse, alcohol use, eating disorders, mental illness, or
physical abuse, etc.
Describe any significant losses you have experienced in your lifetime.
Is faith/spirituality a part of your life? If yes, describe.
Describe what activities you do for enjoyment.
Describe your current and past use of alcohol, drugs and/or tobacco.
Describe any use of counseling. (We view counseling as beneficial. We may simply talk
with you about getting feedback from your counselor.)
Describe your experiences in school.
What is your educational background?
Briefly describe your work history. Include details regarding your current job description.
What were and are your important adult relationships?
How did you and your spouse meet? What attracted you to each other?
What are the strengths and limitations of your marriage (if applicable)?
If parenting, how would you describe your relationship with your child(ren)?
What do you anticipate being the best and the most difficult part of parenting?
What else should someone know about you to understand who you are?
2049 Ridge Avenue | Evanston, IL 60201
847.475.5800 Fax 847.475.5871| www.cradle.org
D:\106742779.doc
About my personality
Please take a moment to reflect on your personality. How would you rate yourself (put a mark somewhere
on the continuum):
Trustful
Skeptical
Risk-taker
Cautious
Needs predictability
Task-oriented
Easily goes-with-the-flow
Procrastinator
Intuitive
Linear
“Couch potato”
Active
Neat
Casual
2049 Ridge Avenue | Evanston, IL 60201
847.475.5800 Fax 847.475.5871| www.cradle.org
D:\106742779.doc
Family Tree for Autobiography
Prepared by: ______________________________________________________________________________________
Name
Name:
City, State:
Birth date:
Education:
Occupation:
Retired?
Marital status:
# of children:
Phys. health:
Deceased?
Date:
Cause:
3 strengths or
weaknesses of
this person:
Name:
City, State:
Birth date:
Education:
Occupation:
Retired?
Marital status:
# of children:
Phys. health:
Deceased?
Date:
Cause:
3 strengths or
weaknesses of
this person:
Parent 1
Parent 2
Step-parent
Other
Significant Adult
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Sibling
Sibling
Sibling
Sibling
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2049 Ridge Avenue | Evanston, IL 60201
847.475.5800 Fax 847.475.5871| www.cradle.org
D:\106742779.doc
Date of birth
2049 Ridge Avenue | Evanston, IL 60201
847.475.5800 Fax 847.475.5871| www.cradle.org
D:\106742779.doc